Computer-implemented methods for executing transactions

ABSTRACT

Computer systems configured to select links in a set of links having associated descriptive information matching information received by the computer system, to arrange the selected links into an ordered list of links responsive to further information, and to transmit at least a portion of the ordered list of links to a remote computer, wherein the list of links are configured to give a user of the remote computer the ability to select any one of the links and, by using the selected link, to access a digital information block associated with the selected link.

RELATED APPLICATIONS

This application is a Continuation of U.S. patent application Ser. No.13/848,496 filed on Mar. 21, 2013 (pending), which is a Continuation ofU.S. patent application Ser. No. 12/958,839 filed on Dec. 2, 2010 (nowU.S. Pat. No. 8,407,254), which is a Continuation of U.S. patentapplication Ser. No. 11/650,344 filed on Jan. 5, 2007 (now U.S. Pat. No.7,870,158), which is a Continuation of U.S. patent application Ser. No.09/439,343 filed on Nov. 15, 1999 (now U.S. Pat. No. 7,657,560); whichis a Continuation of U.S. patent application Ser. No. 08/854,474 filedon May 12, 1997 (now U.S. Pat. No. 6,006,191); which claims Priorityfrom Provisional Application Ser. No. 60/017,316 filed on May 13, 1996.Each of the foregoing applications is commonly assigned and incorporatedby reference herein in their entirety.

TECHNICAL FIELD

The present invention relates generally to diagnostic health care. Morespecifically, the present invention relates to methods and systems forefficient delivery of diagnostic health care. According to one aspect ofthe present invention, systems and corresponding novel methods areprovided for directing “diagnostic medical images” from patients todiagnostic physicians while producing decentralized “diagnostic medicalimage” distribution with control totally in the hands of the patientsand the providers. According to another aspect of the present invention,systems and improved methods for controlling the dynamics of theinteraction between patients and the diagnostic physicians areimplemented such that a “marketplace” for patient images and providerservices is created.

BACKGROUND OF THE INVENTION

Throughout the discussion which follows, various terms will be used todescribe the patient and the several doctors trying to diagnose thepatient's condition. As an aid to understanding, the followingdefinitions shall be adhered to:

-   -   (1) Diagnosis—The art or act of identifying a disease from its        signs or symptoms;    -   (2) Provider—Same as Physician;    -   (3) Gatekeeper Physician—The physician that is actually working        with the patient, i.e., he/she is the one that orders diagnostic        tests for the patient;    -   (4) Patient/gatekeeper—The working unit formed by the patient        and his gatekeeper physician;    -   (5) Diagnostic Physician—The physician who “reads” the results        of a diagnostic modality to obtain a diagnosis of the patient's        problem. The primary examples of these would be radiologists and        pathologists;    -   (6) Digital or Electronic Medical Image (EMI)—A        digital/electronic medical image is an ordered set of numbers in        a computer bulk data file. This ordered set can be        reconstructed, through the use of the computer, into an object        from which a primary diagnosis could be made. This set can be        the representation of a picture, a graph, a diagnostic sound        recording or a recording of physician comments, e.g., audio file        or ASCII text, etc. For a picture, this set of numbers        determines the location of pixels that, when reconstructed on a        computer monitor, would form the image. These numbers also        determine, for each pixel, gray scale, color, intensity, etc.        Any image (e.g. CT, MRI, . . . ) that is by nature in this form        or can be put into this form (e.g. x-ray, pathology slide, . . .        ) and from which a primary diagnosis can be read by a        reconstruction of these numbers (either from a high resolution        computer monitor or from a film derived from these numbers,        e.g., Polaroid Helios)), is a candidate for this system;    -   (7) Digital or Electronic Medical Form (EMF)—this is an        electronic form which contains the necessary background        information on the patient. The fields on this form would        include name, etc, and other indicia as discussed below;    -   (8) Digital or Electronic Medical Record (EMR)—This is the        combination of the EMI and the EMF. It should be noted that the        general term “image” or “EMI” is primarily employed, since        handling of image is of primary importance in both conventional        methods and methods according to the present invention; and    -   (9) Primary Diagnosis—the assessment of some aspect of a        patient's medical condition based on evaluation of a diagnostic        medical image.

It will be appreciated that, in terms of services, the EMR correspondsto a work order package which advantageously includes a work ordersummary (EMF) and a work order (EMI). Alternatively, the EMR can bethought of a Request for Proposal.

The first action a physician generally takes upon meeting a new patientis to try and identify the patient's medical condition or problem. Untilthe medical problem is identified, the medical problem can not beattacked. There are many diagnostic instrumentalities, sometimes calledmodalities, to aid the physician in identification of the patient'smedical problem. These modalities include X-Ray, EKG, EEG, MRI, CT, NM,PET, blood tests, microscope images, etc. Each of these modalitiesproduces a characteristic “diagnostic medical image.” Often, adiagnostic provider (physician) tries to analyze, or read, thediagnostic medical image as a means of helping the gatekeeper physicianarrive at a diagnosis of the patient's problems. The gatekeeper thenuses this to determine a course of action. It could be said that “thebetter the diagnosis the better the health care.”

It will be appreciated that once the image is formed, the actual“reading” by the physician does not require the patient to be present.In actual practice, there are many instances where the diagnosticphysician never sees the patient.

The diagnostic health care system is very large and complex, withhundreds of thousands of providers and millions of patients. It willalso be readily apparent that the diagnostic health care system is asystem filled with inefficiencies and inadequacies. Because of theseproblems, some of which will be discussed below, both patients anddiagnostic physicians suffer.

Moreover, the medical profession, in many areas has not kept pace withand taken advantage of technological improvements, notwithstanding thecritical need therefor. For example, storage and retrieval systems formedical image data such as X-ray films, CAT scans, angiograms,tomograms, and MRI studies are commonly antiquated and often employmethods made popular in the 1920s. Image films used by most diagnosticphysicians are still displayed on an antiquated light box.

Hospitals usually maintain large “file rooms” to store the patient imagedata. The X-ray film image data is typically stored in a large brownenvelope approximately 14 by 17 inches which is open at one end. Thesefilm envelopes can become too bulky to handle and store, especially in acomplex situation in which several of these folders are needed. Theweight of some film image data can often reach 15 pounds or more.Moreover, it is time consuming to obtain image data from file roomseither due to administrative backlogs, lack of specialized filingpersonnel, and misfiling of the image data. In addition, due to thenumerous responsibilities of multiple attending physicians and multipletreatment sites, image data for a significant number of patients isoften misplaced, lost, or at best, difficult to find when needed.

Typically, the physician examines the patient in his/her office afterthe radiological studies have been made in a hospital or diagnosticfacility. These films and the information contained therein are oftenunavailable at the time of the examination unless duplicate films areordered. Thus, there is a need for remote access to these image data forrapid patient assessment and therapy recommendation.

U.S. Pat. No. 5,321,520, which is incorporated herein by reference forall purposes, discloses an automated high definition/resolution imagestorage, retrieval and transmission system for use in hospitals capableof storing, transmitting and displaying medical diagnostic qualityimages for use with medical X-ray films or the like. As shown in FIG. 1,the system disclosed by the '520 patent includes components forprocessing the image data from patient imaging to physician usage. FIG.1 illustrates an automated high definition/resolution image storage,retrieval and transmission system 10 for use with medical X-ray film 12.System 10 includes an image scanning and digitizing means 14 totransform the visual image from the medical X-ray film 12 or otherdocuments into digital data, an image data storage and retrieval means16 to store and selectively transfer digital data upon request, atelecommunication means 18 to selectively receive digital data from theimage data storage and retrieval means 16 for transmission to one of aplurality of remote visual display terminals each indicated as 20 uponrequest from the respective remote visual display terminal 20 through acorresponding communications network 21 such as a telephone line,satellite link, cable network or local area network such as Ethernet oran ISDN service for conversion to a visual image for display at theremote requesting site.

To improve automation and tracking, a machine readable indicia or label22 containing key patient information may be used in association withthe medical X-ray film 12. As shown, the machine readable indicia orlabel 22 is affixed to the medical X-ray film 12 prior to scanning bythe image scanning and digitizing means 14 to provide file access andidentification. Furthermore, digital data from alternate digitized imagesources collectively indicated as 24 and file identification may be fedto the image data storage and retrieval means 16 for storage andretrieval. The major or significant processing stages with regard to theimage data flow include:

(1) PATIENT RADIOGRAPHY: The patient's body is imaged and a film isexposed as in an X ray room, MRI or CAT scan lab.

(2) FILM PREPARATION: The film(s) is developed to create a visible imagewith optical character recognition (OCR) readable patient identificationinformation superimposed thereon.

(3) FILM INTERPRETATION: Commonly, a radiologist drafts an opinionletter for the film(s). This document preferably includes anOCR-readable patient identification label or standard marking area.

(4) IMAGE SCANNING AND DIGITIZING SUBSYSTEM: A scanner subsystemdigitizes each patient image film and/or document on a high resolutionscanner. This digitized data is transmitted by a local high speed datalink to a separate or remote master storage unit. Patient identificationinformation is read from a standard format on each file by OCRtechniques and efficiently stored with the digitized image data.Enhanced scanner resolution and gray scale requirements are provided.Furthermore, to reduce data rate processing, data compaction orcompression is accomplished within the scanner subsystem.

It should be noted here that in order to back-up possible data link downtime or scanner down time, the scanner subsystem may include a CD-ROMdata storage device of some description so that image data may continueto be digitized. The CD-ROM disk may then be manually delivered to thefile room unit for subsequent use. In addition, the digitized data ofone or two images may be written to a compact semiconductor memory card,e.g., a “RAM Card.” This form of data storage may be used to sendselected images for special purposes such as when the image data isneeded in another remote location for purposes of obtaining a secondopinion.

At this point in the image data flow, there is a split in which theoriginal film data is stored as a “master” in a file room and the imagedisk is made available for active “on-line” use in an image storage andretrieval subsystem.

(5) FILM FILING: The patient image films may be placed in the industrystandard 14 by 17 inch brown paper folders and placed on conventionalfiling shelves. Older films can be tagged and stored off-site to reducethe excessive inventory of films found in many hospital file rooms.

(6) IMAGE STORAGE AND RETRIEVAL SUBSYSTEM: This subsystem is a remotelycontrollable, automatically accessible image data subsystem to store andautomatically retrieve, on-demand, the compressed digital informationcontained on the CD-ROM disks. The image storage and retrieval subsystemmay have a high-speed data link connection to the scanning anddigitizing subsystem as well as a write drive recording mechanism whichis dedicated to receiving the data from the scanning and digitizingsubsystem. This CD write drive can operate without interrupting remoteaccess operations.

Remote access to the image storage and retrieval subsystem may beprovided by a variety of telecommunication links. By using several CDdisk drives and electronic buffering, virtually simultaneous access canbe granted to several or more users. However, the medical image diskwill contain relatively huge quantities of data making it impractical tosend over conventional data communication links without very efficientdata compression technology.

(7) TELECOMMUNICATION SUBSYSTEM: Occasionally circumstances may warrantmanually making an extra copy of the patient's image files to bephysically delivered to an authorized requester. However, for the systemto provide broad service to the health care industry it must be able toefficiently telecommunicate image files to remote locations both costeffectively and within a reasonable time interval.

(8) REMOTE DISPLAY TERMINAL: The quality of the image available to theuser is limited or determined by the receiving presentation terminal ormonitor. Two specific presentation terminal types can be used, amodified personal computer terminal for use in a physician's office,hospital nurses' station and the like, and a large screen presentationterminal with remote controlled interaction primarily for operating roomuse. Both terminals have facilities to display the available patientdirectory of images, and facilities to select an image, and to enhanceand zoom in on selected areas of the selected image. Image enhancementhas heretofore been impractical for film-based images and thus muchsubtle but important pathological information has been largely lost.This is especially true of X-ray data. The ability to subtly enhancecontrasted tissue areas is considered to be an important feature andbenefit of the system.

A high-resolution printer of 600 dots per inch (dpi) or better permitsthe physician to print out selected images. This is especially valuablewhen the physician chooses to expand and enhance selected critical imageareas since a cost effective printer would otherwise not have adequategray scale or pixel resolution to give diagnostically useful output.

Each terminal consists of a standard high performance personal computerwith one or more data source interfaces such as a RAM card, a CD-ROMdisk drive or a data modem, a decompression graphics interface circuitand graphics display. The large screen presentation terminal has a largescreen display for easy viewing for a surgeon who may be ten or morefeet distant. The large screen presentation terminal also has anoptional remote control so that an attending technician or nurse canscroll images, enhance and zoom, at the surgeon's request.

One major flaw with the automated high definition/resolution imagestorage, retrieval and transmission system described above is that itmerely assumes that a skilled diagnostic physician such as a radiologistwill be available to read each X-ray film as it is taken. This may notbe the case. For that reason, several hospitals may join a RadiologyHealth Care Network as disclosed in U.S. Pat. No. 5,469,353, whichreference is also incorporated herein by reference for all purposes.

The Radiology Healthcare Network disclosed in U.S. Pat. No. 5,469,353provides high quality, timely medical interpretations of radiologicalimages on a national (e.g., across the U.S.) and regional basis. Theimages can include images created by conventional x-ray technology,computed radiography, magnetic resonance imaging (MRI), computedtomography (CT), ultrasound imaging, nuclear medicine, and mammographyequipment. The network includes the acquisition of these images fromhealth care facilities, the conversion of these images to digitalformat, the routing of these converted images, the interpretation ofthese routed images, and the routing of the interpretations back to theoriginating facility. The images are routed (e.g., on a variety ofhigh-speed digital and analog telecommunication networks) to theappropriate interpretation resource by an administrative site on theNetwork based on one or more requirements associated with the medicalimage study. The interpretation can be performed on high-resolutionworkstations and/or on films produced by film printers. The Networkincludes quality control measures which assure high image andinterpretation quality. The control and tracking of images by theadministrative site results in the production of a complete, signedinterpretive report in a timely manner. See FIG. 2.

From the discussion above, it will be recognized that the currentmedical image distribution technology has the following problems andlimitations:

(1) Diagnostic physicians are often restricted to the local geographicalvicinity of the patient/gatekeeper who requests the medical image to bemade and read. This is particularly true of traditional radiologyservices, but is also true of existing teleradiology services. As notedin U.S. Pat. No. 5,469,353, the diagnostic physician assigned by theadministrator is the one nearest to the point where the medical imagewas generated. It will be appreciated this is often counterproductive,since the diagnostic physician best able to perform the reading may beon the other side of the country. For example, the victim of a car crashat 6 AM in California can take advantage of a large pool of idleradiologists already at work at 9 AM along the entire east coast.

(2) Local diagnostic providers may not be adequate for the patient'smedical needs either for want of competency in a particular area or dueto staffing problems, i.e., a competent diagnostic physician is notavailable when needed. This could result in poor health care andpossibly disastrous results for the patient and, legally, for themedical facility.

(3) The patient has no choice in who reads the image once it has beenmade. In fact, under the current system, i.e., both the traditional andteleradiology systems, there isn't even a way for the patient to knowwho is available to do his/her reading, or at what price. This isn'teven deemed to be relevant information for the patient.

(4) The patient has no voice in determining the fee he/she will pay forthe reading. Many of the new heath plans contain provisions such as“medical savings accounts” which encourage patients to spend his/herhealth care dollar wisely; this is impossible to do when the fee is notknown in advance.

(5) The patient has no mechanism through which to barter. For example,there are medical problems that are not time critical, since mostmedical problems require only reasonable-time readings not real-timereadings. Therefore, a patient should be able to use that fact asleverage for negotiating a lower rate for his/her reading. But undercurrent systems there is no mechanism for doing so. Instead, the patientwho can wait a day and the patient who can wait a week for theirrespective readings now end up paying the same fee as that paid by anemergency patient. Moreover, one of the really peculiar things aboutcurrent health care delivery systems is that the fee paid for a serviceis often not determined by either the person receiving the care or theperson providing the care. Instead, it is determined by some third partysuch as an insurance company, a managed care organization, or thegovernment.

(6) The patient has little ability to interact with the diagnosingphysician; the patient usually can't even find out the status of his/hermedial image reading, let alone have any control over how fast his/herimage is read. For some people this is more important than for others.But if it is important, this uncertainty can have a strong negativepsychological effect. Since it is not unusual for a reading to take aweek, it is not unusual that a patient who is prone to worry can wastemany hours fixating on his/her medical problem.

(7) The diagnostic physician has almost no control over which patientscome to him for readings.

(8) The diagnostic physician can do almost nothing in choosing whichpatients he/she wants to do readings for. He/she can only take or rejectwhatever patients are sent to him from a referring gatekeeper or by thecentral administration of some telemedicine service. The diagnosticphysician is at their mercy; he/she has no access to the overall imagesthat need to be read at any given time.

(9) The diagnostic physician has little control over scheduling; his/herroutine is determined to a large degree by forces he/she has no controlover, e.g., when gatekeepers choose to send him patients, scheduling forthe imaging modalities, etc. This leads to 20%-30% down time, most ofthe down time being of short duration (approximately 15 minutes) andbeing unpredictable as to when it will occur. This inefficiency leads tomajor increases in the overall cost of diagnostic health care. Existingdiagnostic health care systems, including those employing telemedicine,do not address this issue.

(10) The diagnostic physician has little ability to control his/herfees. The gifted provider could charge more if his/her services wereregionally available even though the local market for his/her particularservices does not warrant an increase in his/her fees.

(11) Diagnostic physicians, on the whole, have little ability tospecialize to the degree that they might like to, since their patientpool isn't large enough, in the local region, to warrant specialization.When there is a desire for increased quality, it should be encouraged atevery step. Specialization generally enhances the quality of thediagnostic services provided by the profession. If the size of thepatient base could be sufficiently enlarged, e.g., made national inscope, hyper-specialization would not only be possible butcost-effective.

(12) A medical facility has to be staffed based on anticipated peak workloads, which often means that the inevitable fluctuations in patientflow cause either the diagnostic staff to be over loaded orunderutilized. Moreover, these fluctuations are unpredictable and oftenof short duration.

(13) There is no marketplace that brings together all patients and allproviders.

(14) As discussed above, a Central Administration decides whichdiagnostic physicians should read which images. For the largeteleradiology groups, where there could be hundreds or thousands ofdiagnostic physicians, this is untenable. It is similar to the New YorkStock Exchange telling people which stocks they should buy. It alsocreates additional expenses, i.e., middle men.

(15) The system is not effective in alleviating the long term escalationof provider prices. Efforts by third party payers to reduce providerfees are often only temporarily successful; and

(16) Traditional radiology is changing. It has been theorized that thecountry will soon have only a couple of huge radiology groups. That is,a patient will have no choice but to go to one of these. It will beappreciated that this latter trend could lead to monopolistic practices.

The several different methods for the delivery of diagnostic health carepreviously discussed all suffer from some or all of the problems listedin items (1)-(16) immediately above.

It is desirable that a remote access medical image exchange systeminclude the following major features:

-   -   (1) structures to store and efficiently retrieve image data and        automatically identify the data by patient name, image type,        date and the like;    -   (2) communications channels permitting diagnostic physicians to        remotely access particular patient image data from the system in        near real time;    -   (3) communications channels to quickly and affordably access        image data from the gatekeeper's office;    -   (4) a combination of hardware and software to enhance the        medical images by both contrast enhancement and zooming for        improved diagnostics;    -   (5) software and corresponding hardware permitting the        patient/gatekeeper to quickly ascertain the time by which the        medical image reading will be completed and, if necessary,        reschedule the reading of the medical image;    -   (6) software and corresponding hardware permitting the        patient/gatekeeper to direct the medical image to a particular        diagnostic physician of choice; and    -   (7) software and corresponding hardware permitting the        patient/gatekeeper to direct the medical image to a particular        diagnostic physician or group of diagnostic physicians having a        particular specialty.

In other words, it is desirable to have a remote access medical imageexchange method by which the patient/gatekeeper can set a price for anindividual diagnostic service, and by which the diagnostic provider canuse price to decide whether to accept the offer.

What is needed is a system and operating method therefor to permitbidding for the unused time of diagnostic physicians by patients who donot need real time medical image diagnosis, and/or to permit diagnosticphysicians to bid on available work, and thereby provide an electronicmarketplace for diagnostic services. What is also needed is a system andcorresponding operating method which permits the patient/gatekeeper todesignate a particular diagnostic physician to perform a particulardiagnosis. It will be appreciated that these requirements are criticalto efforts to increase the quality of health care while limiting thecost of health care delivery services.

SUMMARY OF THE INVENTION

Based on the above and foregoing, it can be appreciated that therepresently exists a need in the art for a remote access medical imageexchange system which overcomes the above-described deficiencies. Thepresent invention was motivated by a desire to overcome the drawbacksand shortcomings of the presently available technology, and therebyfulfill this need in the art. In order to address these issues, thepresent invention will be discussed with respect to modemtelecommunications and computer technology. However, it must be clearlyunderstood that telemedicine is not the essence of the presentinvention. In fact, although the Remote Access Medical Image exchange(RAMIX) moves images from one place to another, even that is not theessence of this invention. The essence of the invention is the use of adecentralized, i.e., self-organizing, distribution system combined withbid queues to establish a market place which allows for continuouslynegotiated prices with control (over who reads the images, when they areread and what the fee will be for such a reading) being totally in thehands of the patient/gatekeeper and the diagnostic physician.

An object according to the present invention is to provide a system forconnecting patients with diagnostic physicians wherein the quality ofdiagnostic health care is improved.

Another object according to the present invention is to provide a systemfor connecting patients with diagnostic physicians wherein the cost ofdiagnostic health care is commensurate with the urgency of need andavailability of resources.

Yet another object according to the present invention is to provide asystem for connecting patients with diagnostic physicians wherein thecontrol of much of the overall process is placed squarely in the handsof the patients and the diagnostic physicians.

Still another object according to the present invention is to provide amethod for connecting patients with diagnostic physicians wherein thequality of diagnostic health care is improved.

Another object according to the present invention is to provide a methodfor connecting patients with diagnostic physicians wherein the cost ofdiagnostic health care commensurate with the urgency of need andavailability of resources.

A still further object according to the present invention is to providea method for connecting patients with diagnostic physicians wherein thecontrol of much of the overall process is placed squarely in the handsof the patients and the diagnostic physicians.

These and other objects, features and advantages according to thepresent invention are provided by a buffer memory for storing aplurality of digital information blocks generated by a plurality ofrespective first users in an order established by the first users andreflecting time of arrival, wherein each of the digital informationblocks is receivable by at least one of a plurality of second users,wherein each of the digital information blocks includes an indicia ofthe priority one of the first users attaches to an associated one of thedigital information blocks, and wherein one of the second users electsto receive one of the digital information blocks responsive to theindicia of a respective digital information block.

These and other objects, features and advantages according to thepresent invention are provided by a storage medium for storing computerreadable instructions for permitting a computer to store a plurality ofelectronic medical images corresponding to respective first users, toarrange the electronic medical images in an order established by theelectronic labeling of the electronic medical images, and to downloadone of the electronic medical images to a requesting one of a pluralityof second users based on this order.

According to one aspect, the present invention provides a method foroperating a computer system including a buffer memory accessible by afirst user and a plurality of second users and storing a first digitalinformation block generated by the first user, the digital informationblock being reviewable by a plurality of second users. The methodincludes steps for generating second information blocks responsive tothe first digital information block, each of the second digitalinformation blocks corresponding to a respective one of the secondusers, each of the second digital information blocks including priceinformation established by a respective one of the second users, and allof the second digital information blocks being arranged in an orderestablished by the second users; selecting one of the second digitalinformation blocks based on the price information, the selecting beingperformed by the first user; and receiving the first digital informationblock, the receiving being performed by the selected one of the secondusers of the respective second digital information block selected by thefirst user.

According to another aspect, the present invention provides a method foroperating a computer system including a buffer memory accessible by aplurality of first users and a plurality of second users and storingfirst digital information blocks generated by the first users, thedigital information block being reviewable by the second users,including steps for generating second information blocks responsive toat least one of the first digital information blocks, each of the seconddigital information blocks corresponding to a respective one of thesecond users, each of the second digital information blocks includingprice information established by a respective one of the second users,and all of the second digital information blocks being arranged in anorder established by the second users; selecting one of the seconddigital information blocks based on the price information, the selectingbeing performed by the selecting one of the first users; and receivingthe first digital information block, the receiving being performed bythe selected one of the second users of the respective second digitalinformation block selected by the selected one of the first users.

According to still another aspect, the present invention provides amethod for operating a computer system including a buffer memoryaccessible by a buyer and a plurality of sellers and storing a requestfor proposal (RFP) and an associated work order generated by the buyer,the RFP being reviewable by the sellers. The method permits generatingproposals responsive to the RFP, each of the proposals corresponding toa respective one of the sellers, each of the proposals including priceinformation established by a respective one of the sellers, and all ofthe proposals being arranged in an order established collectively by thesellers; selecting one of the proposals based on the price information,the selecting being performed by the buyer; and receiving the workorder, the receiving being performed by the selected one of the sellersof the respective proposal selected by the buyer. In an exemplary case,the FRP is reviewable by all of the sellers; while the RFP andassociated work order are viewable by the selected one of the sellers.

According to a still further aspect, the present invention provides amethod for operating a computer system including a buffer memoryaccessible by a plurality of buyers and a plurality of sellers andstoring a request for proposal (RFP) and an associated work ordergenerated by each respective buyer, the RFP being reviewable by all ofthe sellers. The method includes steps for generating proposalsresponsive to a respective RFP, each of the proposals corresponding to arespective one of the sellers, each of the proposals including priceinformation established by a respective one of the sellers, and all ofthe proposals being arranged in an order established collectively by thesellers; selecting one of the proposals based on the price information,the selecting being performed by one of the buyers; and receiving thework order associated with the selected WP, the receiving beingperformed by the selected one of the sellers of the respective proposalselected by the one of the buyers.

According to another aspect, the present invention provides a method foroperating a computer system including a buffer memory accessible by abuyer and a plurality of sellers and storing a work order summary and anassociated work order generated by the buyer, the work order summarybeing reviewable by all of the sellers, and the work order summaryincluding price information established by the buyer, includingselecting the work order summary based on the price information, theselecting being performed by one of the sellers; receiving the workorder, the receiving being performed by the selecting one of thesellers; and removing the received work order summary and the associatedwork order from the buffer memory.

According to a still further aspect, the present invention provides amethod for operating a computer system including a buffer memoryaccessible by a plurality of buyers and a plurality of sellers andstoring a plurality of work order summaries and associated work ordersgenerated by the buyers, the work order summaries being reviewable bythe sellers, and each work order summary including price informationestablished by a respective buyer. Preferably, the invention methodpermits selecting one of the work order summaries based on the priceinformation, the selecting being performed by one of the sellers;receiving the work order, the receiving being performed by the selectingone of the sellers; and removing the selected work order summary and theassociated work order from the buffer memory.

According to yet another aspect, the present invention provides acombination including:

-   a first record medium for storing computer readable instructions for    permitting a first computer to store a plurality of first work order    packages corresponding to respective first users, to store a    plurality of second work order packages corresponding to respective    second users, to arrange the first work order packages in a first    order established by all of the first users, to arrange the second    work order packages in a second order established by all of the    second users, to download a first work order corresponding to one of    the first work order packages to any requesting one of a plurality    of third users based on the order established by the first users,    and to download a second work order corresponding to one of the    second work order packages to one of the third users selected by one    of the second users;-   a second record medium for storing computer readable instruction for    permitting a second computer to: generate at least one of the first    and the second work order packages, each generated work order    package including a work order summary and a work order; and monitor    a relative position of a selected one of the first and second work    order packages and for instructing the first computer to modify the    respective work order summary in the selected one of the first and    second work order packages to thereby move the modified work order    package to a new position in one of the orders established by the    first and the second users; and-   a third record medium for storing computer readable instructions for    permitting a third computer to download the requested one of the    first and the second work order packages.

According to a further aspect, the present invention provides a systemfor transmitting, storing, retransmitting and receiving a plurality ofwork order packages, each containing a work order summary having anindicia of the priority attached to one of the work order packages by arespective requester and a work order. Advantageously, the systemincludes:

-   a first computer system including:    -   a first memory storing a first software module containing first        operating instructions readable by the first computer system;    -   an input device for generating at least one of the work order        packages and for changing one of the indicia in the respective        one of the work order packages generated by the respective        requester; and    -   a first display for monitoring all of the work order packages;-   a first communications channel receiving any of the work order    packages generated by the first computer system;-   a second computer system receiving the at least one of the work    order packages from the first communications channel and parsing    received work order packages into their respective work order    summaries and work orders, the second computer system including:    -   a second memory storing a second software module containing        second operating instructions readable by the second computer        system;    -   a summary storage memory for storing the work order summaries        linked to the respective work orders in a predetermined order        based on the indicia in the respective work order packages; and    -   a bulk storage memory for storing the respective work orders;-   a second communications channel for receiving the respective work    order summaries and a selected one of the work orders from the    summary storage memory and the bulk storage memory, respectively;    and-   a third computer system for selecting the selected one of the    respective work orders based on the work order summaries and for    receiving the selected one of the work orders, the third computer    comprising:    -   a third memory storing a third software module containing third        operation instructions readable by the third computer; and    -   a second display for displaying any of the work order summaries        and the selected one of the work orders;        Preferably, the second computer system, under control of the        second operating instructions, reorders all of the stored work        order summaries responsive to any change in the indicia of the        work order packages generated by the respective requester

According to a still further aspect, the present invention provides amethod for operating a computer system including a buffer memory storinga plurality of work order packages awaiting acceptance by a supplier ofone of goods and services, each of the work order packages having anassociated priority indicia assigned by a respective user, the methodincluding steps for storing a user's work order package among theplurality of work order packages; monitoring a rate of change ofposition of the user's work order package relative to the plurality ofwork order packages to thereby determine velocity through the buffermemory to the supplier; and when the velocity is unacceptable to theuser, changing the priority indicia in the user's work order package soas to instruct the computer system to reorder the plurality of workorder packages based on the priority indicia and thereby adjust thevelocity of the user's work order package through the buffer memory.

According to another aspect, the present invention provides a remoteaccess system for purchasing services, including: a first facility forstoring work order packages, each work order package generated by arespective originator and including a work order and an associated workorder summary in a remotely accessible data storage device, to therebyprovide a remotely accessible work order database comprised of thestored work order packages; a plurality of second facilities remote fromthe first facility, but in electronic communication therewith, forproviding a pool of participating service providers with access to thework order database; and means for facilitating interactive bidding bythe originators of the work order packages and service providersregarding the fees to be charged by the participating service providersfor the services requested in the work order packages, whereby thesystem functions as an open electronic marketplace for the distributionof services to the originators. Preferably, the system is configured insuch a manner as to enable any one or more of the service providers toselect and extract one or more of the work orders from the work orderdatabase in accordance with selection criteria established by theservice providers and the work order package originators.

According to a further aspect, the present invention provides a methodfor operating a computer system including a buffer memory storing aplurality of work order packages awaiting acceptance by a serviceprovider, each of the work order packages having an associated priorityindicia assigned by a respective user, the method including steps for:monitoring a rate of change of position of the user's work order packagerelative to the plurality of work order packages; estimating a velocitythrough the buffer memory to the service provider; and when the velocityis unacceptable to the user, changing the priority indicia in the user'swork order package so as to instruct the computer system to reorder theplurality of work order packages based on the priority indicia andthereby increase the velocity of the user's work order package throughthe plurality of work order packages.

BRIEF DESCRIPTION OF THE DRAWINGS

The preferred embodiments are described with reference to the drawingsin which like elements are denoted by like or similar numbers and inwhich:

FIG. 1 is a high level block diagram of a conventional diagnosticmedical image system;

FIG. 2 is a high level representational diagram of a conventionalradiology healthcare network;

FIG. 3 is a high level representational block diagram of a system fordistributing diagnostic medical images according to the presentinvention;

FIG. 4 is a flowchart illustrating the fundamental and supporting stepsof a method of operating the system illustrated in FIG. 3;

FIG. 5 is block diagram illustrating the display of a computer locatedat the gatekeeper's facility according to the system shown in FIG. 3;

FIG. 6 is a block diagram illustrating the various memory areas locatedwithin the clearing house computer illustrated in FIG. 3; and

FIG. 7 is a block diagram depicting the computer screen of a computerlocated at the diagnostic physician's facility according to the systemillustrated in FIG. 3.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

As discussed in detail above, the major problems with the currentdiagnostic health care delivery system are that it is overpriced andinefficient. Moreover, it is run by people who don't have the patient'sor the provider's best interest at heart. The overall result of thecurrent diagnostic health care delivery system is that, at best, it doesno real harm to the patient and, at worst, leaves the patient in poorerhealth after a course of treatment (or non-treatment) dictated by a poordiagnosis. Needless to say, the inefficiencies are financiallydetrimental to all concerned. The Remote Access Medical Image exchange(RAMIX) system and operating method therefor addresses and overcomesevery one of the above-listed problems.

Additionally, the RAMIX system and corresponding operating method solvethese problems by creating a new dynamic system for diagnostic healthcare delivery. The basic goal of diagnostic health care delivery systemsis to bring the patient's image and the diagnostic provider together. Inthe traditional methods, this is done physically. The more recentmethods, teleradiology services, for example, just use technology tobring physicians and images to one location, cyberspace. But none of thepresent diagnostic health care delivery systems change the way thephysicians and the patients interact with one another. That is, they donot change the rules. The RAMIX system and operating method according tothe present invention changes the rules.

The RAMIX system and associated operating method constitute anelectronic forum which employs state of the art telecommunicationsequipment and a decentralized distribution clearing house to create anopen marketplace for diagnostic medical services. The operating methodaccording to the present invention may best be pictured as a cyberspaceenvironment where patients and physicians can negotiate in a direct,often time-delayed, fashion with each other and with their respectivecommunities as a whole. In addition, this is done continuously, i.e., ona case-by-case and provider-by-provided basis. Thus, the RAMIX systemchanges the rules, i.e., the dynamics, which govern the interactionsbetween patient and provider.

Advantageously, the RAMIX operating method according to the presentinvention starts by having digitized patient images sent to aClearinghouse Computer (CHC). It will be appreciated that the CHC (200)advantageously can be a mainframe computer or a dedicated server. Theimage is then placed in one of two separate and different markets areas,so-called Patient Bid Queues (PBQs) and Provider Mail Boxes (PMBs).Preferably, the choice between PBQ and PMB is controlled solely by thepatient/gatekeeper physician. Diagnostic physicians advantageously canaccess both the PBQ and PMB and examine the contents of each beforedeciding if they want to do a reading. If they do, the diagnosticphysician downloads the image(s) and begins the diagnosis.Advantageously, the patient/gatekeeper and the diagnostic physicianpreferably decide which diagnostic physician is going to do the readingand how much the diagnostic physician is paid for this reading. TheRAMIX system acts only as a forum which allows transactions orinteractions between the patient/gatekeeper and the diagnostic physicianto occur.

Beneficially, the invention is based on two facts, namely, the fact thatthe typical diagnostic physician has one or more periods of downtime inthe course of a normal day and the fact that most patients requirereasonable time readings and not real time readings. More specifically,it is estimated that a diagnostic physician can be without medicalimages to read 25-30 percent of the time. Considering that radiologistsaverage somewhere between $225,000 and $450,000 a year, this isextremely inefficient. Additionally, the vast majority of diagnosticimages need to be read in a reasonable time, not real time.

One of the original objectives of and motivation behind the presentinvention was to develop a system, based on modern technology, thatwould take advantage of these two facts in order to provide betterdiagnostic health care delivery. Advantageously, the present inventionevolved into a system and corresponding operating method which addressesall of the problems and inadequacies of the presently availabletechnology described above.

Before discussing the various features and details of the RAMIX systemand operating method, several aspects of the present invention willfirst be discussed briefly in overview in order to provide a usefulframework for the subsequent detailed description. These aspects are asfollows:

(1) The RAMIX system creates a marketplace which is based in cyberspaceand which functions as a direct barter system between the patient andthe diagnostic physician. It should be mentioned that market forces,i.e., supply and demand, are allowed to operate freely. It will beappreciated that competition flourishes in this environment; by virtueof the methodology according to the present invention, diagnosticphysicians compete against each other for images to read, while patientscompete against one another for a diagnostic physician's time.

(2) The RAMIX system according to the present invention is a truemarket; only the buyers and sellers, that is, patients and diagnosticphysicians, determine who reads what image and how much is paid for thatservice. In fact, there is no guarantee that at any point in time therewill be images to read. Moreover, there is no guarantee that imagesplaced on the system will eventually be read. Unlike the stock market,there need be no “market maker” or other type of organizer, althoughthis possibility is not excluded. The RAMIX system functions only toestablish a means for the community of providers to interact with thecommunity of patients.

(3) The RAMIX system provides a self-organizing distribution systemwherein the Patient Bid Queues and Provider Mail Boxes are designed tobe totally controlled both by the patient/gatekeeper and the diagnosticprovider, simultaneously. The diagnostic physician who ultimately readsa particular image is not determined by the RAMIX system. The RAMIXsystem no more determines this than the phone company determines who youshould call. Therefore the RAMIX system according to the presentinvention is not controlled by a bureaucrat, i.e., an administrator atthe central office of a teleradiology service, or some other thirdparty. It will be appreciated that this distribution system isspecifically designed to address the problems stemming from providerinefficiency, which are due to provider downtime and lack of controlthereof.

(4) The RAMIX system according to the present invention provides aspecialized bid mechanism, which is based on ordered sets of queues forindividual bid amounts. The system and corresponding operation methodallow patients to barter with the entire diagnostic physician communityas a whole while, at the same time, providing diagnostic physicians themeans to survey the entire pool (database) of images that requirereading at any given moment.

(5) The RAMIX system and corresponding methods of operation permitconstant monitoring of the image's progress through either the PBQs orthe PMBs by the patient/gatekeeper. Preferably, the patient/gatekeeper,when connected to the RAMIX system, can monitor how fast his/her imageis moving through the queue chosen by the patient/gatekeeper. Thepatient/gatekeeper then has the option to change the selected queue and,therefore, the bid price the patient/gatekeeper is willing to pay forthe reading. This permits the patient/gatekeeper to adjust the velocityof the medical image through the RAMIX system so as to enable an earliercompletion time for the reading more to the patient/gatekeepers liking.In essence, the ability to reselect the PBQ or position in the PMB wherethe medical image of interest resides allows for continuous negotiatingof the bid price for the reading service. It should be mentioned thatthe reselected position could establish a lower priority, i.e., bidprice, if the patient/gatekeeper determines that the medical image ismoving through the selected PBQ too rapidly. For example, if the patientis scheduled for a consultation in three days, the patient/gatekeepermay select or reselect a PBQ which has an average two day velocity,i.e., a medical image placed in that particular PBQ will probably beread in 48 hours of less, so that the reading will be completed beforethe consultation with the gatekeeper and at the lowest possible price.

(6) Within the RAMIX Clearing House Computer are located Patient BidQueues (PBQs), which contain a pointer or link to patient electronicmedical images. Each PBQ has an associated bid that all of the patientsin that PBQ are willing to pay the diagnostic physician to have theirmedical image read. Preferably, PBQs are arranged in descending order atincrements, e.g., 5%, of the average price that the patient/gatekeeperis willing to pay for the reading. In an exemplary case where theaverage price for a reading is $100, the PBQs would be establishedindicating prices of $120, $115, $110, $105, $100, $95, $90, $85, $80,etc. Within any particular PBQ, the images are arranged in “First In,First Out” (FIFO) order, i.e., time of receipt order. Note that thepatient with the highest bid amount, and who is at the top of the FIFOorder, is guaranteed to get his image read by the next diagnosticprovider who is willing to do the reading for that amount, while thefirst diagnostic physician who decides to do a reading from this array,is guaranteed that the RAMIX software will download the image with thehighest bid to him/her.

It should be noted that there could be an array of PBQs, for eachadditional criteria such as medical subspecialty and/or modality. Forexample, all EMR's for neurological MRI1s advantageously can be puttogether into an array of queues as described above. In addition, therecould also be another array of queues for all EMR's of CT's, and so on.Diagnostic providers are free to look into any of these arrays whichthey are qualified to read from. For example, PBQs may be establishedusing both price and an additional criteria to form a matrix of PBQs.For example, different columns advantageously can be established forhead, chest, and extremities with each row of a particular column beingassigned a set price. It should also be mentioned that each row of thematrix need not reflect an uniform bid price; preferably, each rowcorresponds to a standard percentage change of the average price.

Additionally, it should be noted that an additional PBQ could beestablished to permit the diagnostic physician to provide charitablereadings should the diagnostic physician choose to do so. Thus, anindigent PBQ could be established for this purpose. This PBQ would have$0.00 associated bid price. RAMIX software could keep track of eachprovider's charitable readings. This could then be used for a variety ofpurposes among which would be income taxes.

(7) The RAMIX system and operating method according to the presentinvention advantageously would include Physician Mail Boxes, whichstores links, i.e., pointers, to electronic medical images (EMIs)arranged in fee amount order, i.e., the fee amount that each patientagrees to pay the particular diagnostic physician for his/her reading.It will be recognized that the very nature of the RAMIX system of thepresent invention includes no provisions obligating a patient to send animage to a particular provider. Moreover, under the inventive system andoperating method, no diagnostic physician is guaranteed that images willbe sent to him and no diagnostic physician is obligated to perform anyreadings even if medical images are specifically sent to him. Each PMBwill contain arrays of queues just as the PBQ area does, but only thespecified diagnostic provider will be able to enter it and downloadimages.

(8) Advantageously, the RAMIX system and corresponding operating methodcan provide for distribution of biographic material on each diagnosticphysician, both online and in hard copy form. Preferably, thepatient/gatekeeper will refer to this biographic material so as topermit the patient/gatekeeper to make an informed choice if the patientprefers to select a particular diagnostic provider, e.g., a highlyreputable specialist in the area of concern. As part of the RAMIXsystem, each radiologist would provide a biography with information suchas medical school attended, publications, affiliations, residency, etc.

(9) According to one aspect of the present invention, the RAMIX systemand operating method therefor permits the patient to negotiate with apool of “just in time physicians.” More specifically, if at any givenmoment the patient's bid is the highest in all of the PBQs, that patientis guaranteed that the next available diagnostic physician will addresshis/her image. That is, the patient is only negotiating with thoseproviders who are free to do a reading at that particular moment and alldiagnostic physicians in that “available” group are competing with eachother to do the reading; thus the patient is virtually guaranteed thatonce the medial image is selected, the medical image will be readquickly. One of the particular advantages of the present invention isthat there is no need for a functionary at a central administrationlocation to decide which diagnostic physician has the time to do thatparticular reading; the diagnostic physicians do that themselves.

(10) According to another aspect of the present invention, the RAMIXsystem and corresponding operating method advantageously provides “justin time” medical images. As discussed above, 30% of any diagnosticphysician's time is wasted during the day because the diagnosticphysician has no images to read. This problem of 30% diagnosticphysician downtime is exacerbated by the fact that the downtime comes insmall units, e.g., 15 minutes of downtime. Moreover, the diagnosticphysician cannot predict when the downtime will occur. The RAMIX systemand operating method of the present invention were motivated by a desireto address this problem. Preferably, the RAMIX system addresses theproblem by the combination of pooled patient medical images, and adecentralized distribution system. Moreover, the RAMIX systemadvantageously provides high bandwidth downlinks to the diagnosticphysician performing the reading. It should be noted that the poolingpreferably is accomplished through the PBQs and the pooling is possiblebecause only “reasonable or just in time” readings are usually required,not “real time” readings. This results in images being presented to thediagnostic physician exactly at the time the diagnostic physicianreaches an idle point in his/her day, i.e., “just in time” medicalimages.

At this point it should also be mentioned that a secondary advantage ofthe RAMIX system according to the present invention is that itencourages efficiency on the part of the diagnostic physician. As aradiologist goes through his/her day, knowing that MIX is there willcause him to work more efficiently. Heretofore, the diagnostic physicianknew that there were only so many images that he/she would be requiredto read during a typical day; thus, there was no reason for thediagnostic physician to be efficient. Now there is. Once the diagnosticphysician is finished with a locally generated reading, the diagnosticphysician can select and download a medical image from the RAMIX system.

(11) Hyper-specialization among diagnostic physicians is another aspectaccording to the present invention. Hyper-specialization occurs for tworeasons. First, the diagnosing physician can restrict those allowed toplace images in his/her mail box to the specialty that he/she wants.Second, each diagnostic physician advantageously can look over thePatient Bid Queues and pick from them medical images in his/herspecialty area. Basically, this allows each diagnostic physician toincrease his/her patient base. It should be mentioned thathyper-specialization also can lead to the creation of diagnosticphysician “stars”; thus, a radiologist who is truly gifted at his/herwork can demand a certain fee that he/she would not normally be able toget.

(12) Another advantageous result of the RAMIX system and associatedmethod of operation is that it complements the existing practice of manydiagnostic physicians. Moreover, because diagnostic physicians are underno obligation to do readings, the system does not inflict itself on anexisting practice. Each individual physician, and only the physician,decides when he/she would like to perform a diagnostic reading on amedical image placed on the RAMIX system. The RAMIX system beneficiallycomplements the diagnostic physician's existing practice and allows thediagnosing physician to work more efficiently.

In summary, the overall objects of the present invention are to (1)improve the delivery of diagnostic health care while (2) providingpatients and diagnostic physicians more control over diagnostic servicesand the price paid therefor then they have currently. With thisbackground in mind, the present invention will now be described withreference to FIGS. 3-7.

Referring first to FIG. 3, the RAMIX system 100 according to the presentinvention includes a clearing house computer (CHC) 200, whichadvantageously receives, stores and downloads medical images requiringdiagnostic readings and receives, stores and transmits reports regardingdiagnostic readings performed on medical images. Preferably, the CHC 200is a distributed computer network with redundant transmission andstorage capabilities; the CHC 200 advantageously can be a server in alarge scale intranet. Other hardware configurations are possible so longas the functions described below can all be performed.

Preferably, the CHC 200 is connected to a imaging center 300, whichcenter advantageously includes, in an exemplary case, a scanner 320which is connected to CHC 200 via a computer 310 and a communicationschannel 210. It should be mentioned that the scanner 320 and computer310 depicted in FIG. 3 are exemplary only. The system disclosed in U.S.Pat. No. 5,321,520 advantageously can be used to convert conventionalx-rays into EMIs on a much larger scale. It should also be mentionedthat many conventional devices which produce an electronic medical image(EMI) as an output develop the medical image in digital form and thenprint the image as a hard copy. For example, U.S. Pat. No. 4,603,254,which patent is incorporated herein by reference for all purposes,discloses a stimulable phosphor sheet carrying a radiation image storedtherein which is scanned with stimulating rays, i.e., a laser beam, todevelop the stored image. The amount of light emitted from thestimulable phosphor sheet is proportional to the amount of radiationenergy stored therein. The emitted light is detected and converted intoan electric signal, which is subsequently converted into a digital datasignal. The digital data is then used in creating a radiation image onfilm for use in diagnosis and subsequent storage. It should be notedthat although U.S. Pat. No. 4,603,254 was discussed in U.S. Pat. No.5,321,520, the latter patent did not appreciate that the scanner couldbe dispensed with when an EMI can be generated without use of anintermediate hard copy. This advantageously reduces degradation in theEMI transmitted to CHC 200. In short, while the imaging center 300necessarily generates the EMI transferred to CHC 200, many variations ofthe hardware located at imaging center 300 are possible and allvariations fall with the scope of the present invention.

Preferably, communications channel 210 can be a high speed dedicatedtransmission line, as discussed in detail below. Alternatively,communications channel 210 encompasses any method of conveying an EMI toCHC 200 in a timely fashion. The only requirement is that the digitalintegrity of the image be maintained. In an exemplary case, EMIs whichmust be read in “real time” could be electronically transferred while“reasonable time” EMIs could be transferred to a compact disc read onlymemory (CD-ROM) or digital Video disk (DVD) and sent by courier serviceto either the facility housing the CHC 200 or a facility having adedicated high speed line to the CHC 200.

Systems according to the present invention can use various digitalcommunication links for transferring EMIs between the imaging center300, e.g., a hospital or a radiology clinic and the CHC

200. The digital links can include, in no particular order, (1) ATM andSONET links which operate at between 56 Mbits/sec and 2 Gbits/sec, (2)T3/DS-3 digital point-to-point services which operate at 44.746Mbits/sec, (3) T1/DS-1 carrier point-to-point services which operate at1.544 Mbits/sec, (4) satellite personal computer point-to-point serviceswhich operate as 400 Kbits/sec, (5) DS-0 digital services which operateat 64 Kbits/sec, (6) Frame Relay links that operate at between 9,600bits/sec and 1.544 Mbits/sec, (7) Ethernet or 802.3 LAN links whichoperate at 10 Mbits/sec, (8) IEEE 802.6 standard metropolitan areanetworks (MANS), and (9) ISDN (Integrated Services Digital Network)end-to-end services. The above list is not meant to be exhaustive; otherforms of communications channels advantageously can be employed.

Still referring to FIG. 3, CHC 200 is also connected to the diagnosticphysician's office 400 and the gatekeeper's office 500. Preferably, thediagnostic physician's office includes a high resolution graphicsworkstation 410 which preferably is connected to CHC 200 via both highand low capacity communications (comm) channels 220 and 230,respectively. Low speed comm channel 230 advantageously can include apair of analog or digital modems 232, 234 connected to one another viaconventional phone lines. Preferably, the comm channel 230 includes ISDNmodems 236, 238, which provide additional bandwidth during the selectionprocess, as discussed in greater detail below. Moreover, comm channel220 advantageously includes earth stations 222 and 226, which arecoupled to one another by satellite 224. In addition, the gatekeeper caninclude a low resolution workstation or personal computer 510, which canbe connected, in an exemplary case, to CHC 200 via comm channel 240.Advantageously, comm channel 240 includes a pair of modems 232 and 242.It will be noted that modem 232 is common to both comm channels 230 and240 since the diagnostic physician and gatekeeper will be connected tothe CHC 200 at the same time only infrequently. It will also beappreciated that modem 232 advantageously can represent a modem poolhandling numerous calls from various offices 400, 500.

The inventive method according to the present invention whichadvantageously can be used in operating the RAMIX system 100 illustratedin FIG. 3, will now be described with reference to FIGS. 4-7.

During step 600, the gatekeeper determines that a medical procedurewhich will ultimately result in the creation of an EMI is necessary andorders the procedure for the patient. As discussed above, the procedureis assumed to be, for the purposes of this description, a series ofx-rays; in reality, the procedure is any medical procedure which can bedigitized and can be provided to a diagnostic physician for reading. Thegatekeeper uses his/her computer to fill out the form which instructsthe imaging center 300 to perform the required procedure. It should bementioned at this point that the form advantageously may be printed outby the gatekeeper, signed, and given to the patient. In appropriatecircumstances where the gatekeeper's computer 510 is or can beinterconnected to the computer 310 at imaging center 300, the gatekeeperphysician can schedule the patient for the needed procedure. Preferably,the form is also sent electronically to the imaging center 300.

The computer 510 in the gatekeeper's office 500, as well as the computer310 at the imaging center 300, include specialized software forconnecting to the CHC 200. The software contains an electronic medicalform (EMF), which is filled out by the patient/gatekeeper. All of thenecessary medical information is entered into the EMF, with allinformation being entered in “fields” which can be used to track andcontrol the reading process, as discussed in greater detail below.Preferably, the EMF can include the Acquisition Site IdentificationNumber, Gatekeeper Identification Number and a Patient IdentificationNumber. The operating software turns the EMF is into a computer file andelectronically attaches the digitized “diagnostic medical image” to theform. The entire computer file thus becomes the patient's ElectronicMedical Record (EMR). Finally, a Document Control Number (DCN) isassigned to the patient's EMR, which advantageously allows thepatient/gatekeeper, the diagnostic physician performing the reading, andthe operating system of the CHC 200 to follow (track) and access the EMRas it moves through the RAMIX system. Preferably, security measurese.g., passwords, are implemented to maintain the privacy of thepatient's EMR. It will also be recognized the DCN advantageously mayinclude identifiers to indicate such things as the acquiring modalityand subspecialty within the modality, to all system users.

During step 600, the patient/gatekeeper decides whether the EMI shouldbe read by a particular diagnostic physician, in which case the form onthe gatekeeper's computer 510 will contain the PMB of the selecteddiagnostic physician and a bid price for the reading, or be placed inthe PBQs, in which case the completed form will contain only the bidprice. The patient/gatekeeper makes the decision based on theinformation provided by the RAMIX system, i.e., the CHC 200, asdiscussed in greater detail below.

As shown in FIG. 5, the display of computer 510 includes four distinctareas 512, 514, 516 and 518. Preferably, area 512 is reserved forpatient data such as the form ordering the needed procedure while area514 displays information regarding the PBQs and PMBs. In addition, area516 is dedicated to messages such as the diagnosis performed by thediagnostic physician, which will be discussed in greater detail below.Area 516 on the screen of computer 510 advantageously may also be usedto display biographical information on diagnostic physicians to thepatient/gatekeeper. Beneficially, screen area 518 allows thepatient/gatekeeper to view a low resolution version of the medicalimage, or a high resolution of the pertinent parts of the EMR, once thediagnostic physician's reading has been performed. It should also bementioned that the relative sizes of areas 512, 514, 516 and 518 are forillustrative purposes only. Moreover, while the areas, which aregenerated by graphical user interface (GUI) software, could be resizedfor various tasks or according to physician preferences, preferably theareas have a predetermined size and arrangement so that the gatekeepercan readily grasp the displayed information.

In the preferred embodiment, in order for a diagnostic image to be readon the RAMIX system, the patient's EMR must be placed in either a PBQ ora PMB, as discussed above. A “field” is provided on the patient'selectronic medical form to permit selection between the PBQs and a PMB.In either case, the patient's electronic medical form must also speciethe bid price, i.e., the price he/she is willing to pay, for thediagnostic reading. Advantageously, a bid price need not be specified inalternative embodiments of the present invention. Alternatively, thepatient advantageously can “shop around” for a diagnostic physicianbased on a specified asking price posted within the biographicalinformation resident in the RAMIX system.

It must be mentioned that only the patient/gatekeeper determines thepath the EMR will take to arrive at the desk of a diagnostic physician;the RAMIX system plays no part in making this decision. Thus, the EMRcould be routed to the diagnostic physician either via a PBQ or via aPMB.

It will be appreciated that in order for the patient/gatekeeper to makean educated determination of the routing to the diagnostic physicianwhich best suits the patient's needs, the patient/gatekeeper should haveaccess to information such as:

-   -   (1) The bid price of each PBQ and ask price for each reading        physician, i.e., the nominal asking price set by each diagnostic        physician for his/her respective PMB;    -   (2) The total number of patients in each PBQ and each PMB;    -   (3) The average velocity, i.e., propagation time or speed,        through each PBQ and PMB;    -   (4) The average velocity through each PBQ and/or PMB at a given        time of the day;    -   (5) An estimate by the RAMIX system as to approximately when a        reading would normally occur based on where the patient might        place his/her medical image; and    -   (6) Detailed Biographies of all reading providers. This        information is provided to the patient/gatekeeper via the        computer 510 from CHC 200, preferably in area 514 of the        computer's screen. It should be mentioned that once the image        has been sent to the RAMIX system, the patient/gatekeeper may        order his/her image moved to a different queue. In order to        facilitate this decision, the patient/gatekeeper advantageously        has access to the information noted above, as well as the        current position in the queue of the patient's image, and the        information regarding movement through the selected queue, as        discussed in greater detail below.

Advantageously, the patient/gatekeeper makes use of all of theabove-mentioned information available to him in deciding which is thebest choice, PBQs or PMBs, for bidding on the reading of his/her medicalimage. Preferably, one or more of the following variables can be takeninto consideration when the selection is made:

-   -   (1) The urgency of the reading;    -   (2) The difficulty of the reading;    -   (3) The expertise of the reading physician; and    -   (4) The financial situation of the patient.        With this information in hand, the patient/gatekeeper can        intelligently control the reading, in that the patient can now        pick the best PBQ or PMB for his/her needs and reflective of        his/her financial status.

As discussed briefly above, there are two types of locations where apatient/gatekeeper can place a medical image for reading: Patient BidQueues (PBQs); and Provider Mail Boxes (PMBs). Together these locationscreate a forum or marketplace for electronic medical images and providerservices, allowing patients to bid for provider services while allowingdiagnostic physicians to compete with one another to provide thediagnostic services desired by the patients. With the preferredembodiment of the system and method of the present invention,negotiating is performed anonymously, not one-on-one between a singlepatient and a particular provider, although this possibility is notexcluded. In other words, according to the system and correspondingmethod of the present invention, any negotiating is done en masse, notface-to-face between a particular patient and a particular provider.Which PBQ or PMB a medical image is placed in is strictly up to thepatient and his/her gatekeeper physician; the RAMIX system is no moreinvolved in this selection than the phone company is involved inselecting the telephone calls the patient makes. Of course, it will beappreciated that the RAMIX system does not permit connections todiagnostic physicians who are not subscribers.

As previously mentioned, Provider Mail Boxes (PMBs) allow patients tobid against one another for a particular diagnostic physician's time.Each reading physician is assigned his/her own Mail Box, which willcontain, at any one time, a listing of all of the patients who arespecifically requesting that the diagnostic physician diagnose theirmedical image. Within the RAMIX system, the PBM is divided intodifferent subdirectories based on the amounts that the patients arewilling to pay for the reading of their respective medical images. Thepatient image is listed under the amount that they are willing to pay ona FIFO basis. An exemplary arrangement of subdirectories labeled withbid prices is show in Table 1. It should be noted that a similar arraycould appear for each modality.

TABLE 1 $400 $390 $380 $370 $310 $280 — — — — — — —

The CHC 200 advantageously can provide the patient/gatekeeper withstatistical information about the provider's mail box including averagespeed through an array of queues, the number of patients at each bidamount, and the average amount accepted by the provider to do thereading, etc.

Preferably, the CHC 200 can provide additional specific informationincluding the current status of the reading physician, e.g., whether thediagnostic physician is in town, and the asking price of the diagnosticphysician for any reading. It will be appreciated from the discussionimmediately above that a patient need not offer the diagnostic physicianhis/her asking price. The patient may decide to offer the diagnosticphysician a premium, which will likely result in a short delay, or maychoose to offer a discounted price, knowing that the discounted pricewill likely result in a longer delay.

It will be appreciated that the contents of Table 1 are changingcontinuously as images come in from patients and are downloaded by thediagnostic providers. In particular, the highest bid price will bechanging also. This results in a situation where the bid price offeredto the diagnostic physician is being continuously negotiated on acase-by-case and provider-by-provider basis. The same will hold true forthe PBQs, as discussed in detail below. Advantageously, when theinformation is changing rapidly, the provider selects an image, asdiscussed with respect of FIG. 4, by choosing the next available image,irrespective of the fee offered, or choosing the next available image atthe current maximum bid price. It will be appreciated that the latterchoice may mean that the provider may not obtain an EMR for readingduring the present downtime period.

When the patient/gatekeeper requests that a particular diagnosticprovider perform the reading, the patient's EMI advantageously containsboth the PMB address and an amount the patient is willing to pay for thediagnostic service. Advantageously, the patient/gatekeeper can alsospecify such things as the time limit for doing the reading and analternative diagnostic physician so that, in the event that the primarydiagnostic physician cannot or will not complete the patient's readingbefore the time expires, the patient's EMR is transferred to the PMB ofa secondary diagnostic physician. As will be discussed in greater detailbelow, once the medical image has been sent to the CHC 200, the softwareoperating the CHC 200 will enter the EMR into the physician's mail boxand reprioritize all EMRs according to the bid amounts offered for theservices. Once the physician logs on to the RAMIX system, he/she canenter his/her personal PMB using a security code, and look over thedirectory of EMR labels identifying medical images that are waiting tobe read. The diagnostic physician will determine whether to read orreject any particular image. Moreover, the diagnostic physician alonedecides what fees he/she will accept or reject for his/her reading. Itwill be appreciated that for those physicians who are truly gifted inthe profession the demand for their diagnostic services will be highand, thus, they can justifiably charge higher amounts for theirservices, according to the basic law of supply and demand in a free andopen marketplace. It should also be mentioned that the RAMIX systemplaces no restrictions on how fast the medical images must be read,unlike those in the patient bid queues.

It should also be recognized that the above configuration of the PMB isan exemplary arrangement; other arrangements are possible. For example,all medical images sent to a particular physician's mail boxadvantageously may be shown in a consolidated listing sorted on the bidprice offered for the reading and the date-time the EMR containing theEMI is received by the CHC 200, as shown in greater detail in FIG. 6. Itwill be appreciated from FIG. 6 that the actual medical recordsadvantageously can be stored in a buffer memory such as a redundantarray of inexpensive drives (RAID) buffer memory or an optical memorysuch as an optical juke box, Preferably, the contents of the PBQs andPMBs are pointers, links or shortcuts to the actual EMRs containing therespective EMIs, which preferably are stored in RAID memory within orattached to CHC 200.

In contrast, PBQs allow diagnostic providers to compete with one anotherfor the privilege of performing EMI readings. As discussed above, thepatient/gatekeeper advantageously can choose to place the medical imageon the “open market,” i.e., so that the EMI will be addressed by thediagnostic physician community as a whole. It will also be noted that inthis situation, the choice of diagnostic physician is relinquished inreturn for the opportunity to have the reading performed during whatotherwise would be the diagnostic physician's average 30% downtime.Advantageously, even though the medical image is being placed in one ofthe PBQs, quality is maintained by virtue of the fact that all providersconnecting to the CHC 200 preferably are Board Certified diagnosticiansin their particular field.

The Patient Bid Queues (PBQs), in an exemplary case, are computerdirectories of Electronic Medical Records (EMRs) which are arrangedaccording to the fee the patient chooses to bid for the reading ofhis/her EMI. A representative arrangement is illustrated in Table 2.

TABLE 2 Statistics $105 $100 $95 $90 $85 $80 — — — — — — — — — — — — — #0 1 27 27  12 8 Time 0 .5 25 48 120 1482

Additional details regarding each PBQ are listed immediately below thePBQ. For example, the line denoted # indicates the number of EMIs ineach queue awaiting a reading. The line labeled Time indicates theestimated time in minutes to reach the top of the individual PBQ.Additional statistical information, such as that discussed above,advantageously can be provided to the patient/gatekeeper so as to permitinformed selection of one of the PBQs.

It should again be mentioned that the above configuration of the PBQs isan exemplary arrangement; other arrangements are possible. For example,all medical images sent to the PBQs advantageously may be shown in aconsolidated listing sorted on the bid price offered for the reading andthe date-time the EMI is received by the CHC 200, as shown in greaterdetail in FIG. 6. As mentioned previously, the actual EMRsadvantageously can be stored in a buffer memory such a redundant arrayof inexpensive drives (RAID) buffer memory or an optical memory such asan optical juke box; the contents of the PBQs and PMBs can be pointers,links or shortcuts to the actual EMRs containing the EMIs to be read,which advantageously can be stored in a RAID memory within or attachedto CHC 200.

Still referring to step 600, the patient/gatekeeper displays the PBQsand information about each of the PBQs. In another exemplary case, thedisplayed information advantageously can be, but is not limited to, thefollowing:

-   -   (1) The total number of patients in each of the PBQs (See “#”        line in Table 2.);    -   (2) The average velocity through each of the PBQs (See the        “Time” line depicted in Table 2.);    -   (3) The average velocity through each of the PBQs at a given        time of the day; and    -   (4) The estimated time when a reading would occur based on entry        of the EMI at the current moment.        With this information at their disposal, the patient/gatekeeper        advantageously can select an appropriate one of the PBQs        reflective of the patient's needs and resources. When the        patient's EMR containing a PBQ designation is transmitted to CHC        200, the operating system software of the CHC 200 automatically        reads the appropriate field and assigns the patient's EMR to an        appropriate location in the selected PBQ.

During step 602, a diagnostic image of the patient is generated at theimaging center 300. The diagnostic image is then digitized by scanner320, in an exemplary case, and integrated with the electronic formstored in computer 310, which was previously provided by thegatekeeper's office, to produce the patient's EMR, i.e., the patient'sElectronic Medical Record, which is then transmitted to the CHC 200 viathe comm channel 210, also during step 602.

It should be mentioned that the exact order for performing steps 600 and602 is not critical to the inventive method. For example, when theimaging facility is located in a hospital, the diagnostic imageadvantageously can be made first during step 602 and then thepatient/gatekeeper can determine the best routing, i.e., to a PBQ or aPMB, for the patient's needs. However, when the imaging center is remotefrom the gatekeeper's office, the patient/gatekeeper advantageously canmake a preliminary selection, since, as discussed in detail below, thepatient's selection can be modified until the EMR is either previewed orselected by a diagnostic physician.

As mentioned above, the patient's EMR containing an associated EMI istransmitted from computer 310 to CHC 200 via comm channel 210, i.e., theEMR is sent from the imaging center 300 to the CHC 200. It should benoted that the only restriction on the method of transmission and, thus,on the comm channel itself, is that the transmission method used mustguarantee that the patient's EMR received at CHC 200 is identical to theEMR residing at the imaging center 300. Those of ordinary skill in thedigital communications art will appreciate that there are a myriad ofmethods for ensuring the transmission accuracy of the EMR, all of whichare considered to be within the scope of the present invention. Themethod employed in implementing comm channel 210 is solely determined bythe imaging center's abilities and the patient's needs and financialresources. It should be clearly understood that the particularimplementation of the comm channels has no bearing on the presentinvention as long as it maintains the digital integrity of the EMR.

Once the EMR with its included EMI is received by CHC 200, thecomputer's operating system stores the EMR in the EMR Storage area andsearches the stored EMR for the particular field which contains theinformation specifying the location where the patient's EMR is to beentered, i.e., either into one of the PBQs or one of the PMBs. Theoperating software of the CHC 200 then places the Document ControlNumber corresponding to the patient's EMR in the appropriate Patient BidQueue (PBQ) or Provider Mail Box (PMB). The operating program thenadvances to step 604.

The progress of the EMI through the selected PBQ or PMB advantageouslycan be monitored during step 604. The computer 510 at the gatekeeper'soffice 500, and possibly, the computer 310 at the imaging center 320,preferably includes software which allows the patient or thepatient/gatekeeper to monitor the progress of the patient's EMI throughthe chosen location, i.e., chosen PBQ or PMB. See, for example, the commchannel 240 in FIG. 3. By highlighting or selecting the DCN for his/herEMR, the patient will be able to determine the relative velocity ofhis/her EMR through the selected PBQ or PMB. It will be appreciated thata negative velocity indicates that the patient's EMR is being drivenfurther down the overall prioritized list of EMRs awaiting readings byother patients who are bidding more for the downtime of the pool ofdiagnostic physicians. As noted in FIG. 3, this monitoringadvantageously can be performed, in an exemplary case, over normal phonelines and a pair of modems 232, 242.

During step 604, the patient reviews the progress of his/her own EMR todetermine subjectively whether the velocity through the PBQs or selectedPMB is acceptable. When the patient/gatekeeper decides that progress isunacceptable to the patient, the patient/gatekeeper advantageously canremotely request that the priority the patient attaches to his/her EMIbe increased, i.e., the patient/gatekeeper can change the bid price. Forexample, if the patient notes that his/her EMR currently has a negativevelocity, the patient/gatekeeper could simply increase the bid price bychanging the information on the selection field of the patient's EMF andtransmitting the change to CHC 200 via comm channel 240 during step 608.When the patient's corresponding EMR on CHC 200 is updated with the newbid price, the DCN for the patient's EMR would move from its currentposition to the bottom of the newly selected one of the PBQs. Bychanging to a “higher” PBQ, the patient will shorten the time perioduntil his/her EMR will be read, i.e., the estimated time of reading theassociated EMI will be moved up. This process allows for the continuousnegotiation of the bid price, i.e., it creates a free marketenvironment.

During steps 600, 602, 604 and 606, the patient/gatekeeper retainedcontrol of the patient's EMI contained in a respective EMR; once thediagnostic physician starts the evaluation of the patient's EMI at step608, the patient/gatekeeper will no longer be able to effect changes tothe patient's bid price, at least in the preferred embodiment accordingto the present invention being discussed.

As a diagnostic physician goes through his/her day, there are momentswhen the diagnostic physician suddenly finds himself with 15-20 minutesof downtime, i.e., with no readings to perform. During this downtime,the diagnostic physician advantageously can access the RAMIX system,represented by CHC 200 in FIG. 3, and examine the PBQs, starting withthe highest-ranked active PBQ. There, the diagnostic physician sees thepool of waiting patients and the amount they are willing to pay thediagnostic physician for diagnostic services. In the event that thediagnostic physician desires to perform a reading of an EMI, thediagnostic physician can request that the EMR carrying the highest bidprice be downloaded to him. It should be noted that as far as theservice provider is concerned, this is equivalent to having a “just intime” image to read.

As an example, in a large community such as New York City there areseveral hundred radiologists. At any given moment there will always be asignificant number who have no EMIs to read. The inventive method andsystem therefor provide the patient with a way of negotiating with allidle diagnostic physicians as a group to do the patient's reading.Advantageously, this means that a central administration, i.e., a middleman, is completely unnecessary.

Each diagnostic reading site, e.g., hospital or diagnostic physician'soffice 400, includes a computer 410 with operating software capable ofconnecting the computer 410 to the CHC 200 via both comm channels 220and 230. When one of the diagnostic physician's local work load permits,that diagnostic physician connects to CHC 200 to check both his/herpersonal PMB and the PBQs during step 608. If the diagnostic physicianchooses to examine the PBQs, the information displayed in area 414 ofthe screen of computer 410 preferably corresponds to the active PBQ withthe highest bid price. Preferably, the DCNs of the patient's EMRs forthe highest active PBQ are listed in time of receipt order. If thediagnostic physician is willing to perform a reading for the bid price,the diagnostic physician requests that the patient's EMI andcorresponding EMR be downloaded to him. Preferably, this subroutineincludes steps for screening the EMIs, during steps 608 and 610, as wellas downloading the EMR containing the selected EMI during step 612, asdiscussed in greater detail below. If the diagnostic physician choosesnot to do a reading for an image in this area, the diagnostic physiciancan either transfer to another array area, or to his/her PMB, or signoff the RAMIX system. These additional steps (not shown) can beimplemented when the response at step 610 is negative.

During step 608, the diagnostic physician receives a list of DCNscorresponding to the patient EMIs available for reading. The diagnosticphysician selects the first DCN in the list. This selection results inseveral simultaneous actions in CHC 200. First, all of the otherdiagnostic physicians reviewing the same PBQ are locked out of the EMRhaving the selected EMI. Second, the CHC 200 transmits the EMR includingpatient information from the EMF, which preferably is displayed in area412 on the screen of computer 410, and a preview image corresponding toeither the sole or first digitized diagnostic image in the patient'sEMI. It will be appreciated that the size of the actual digitizeddiagnostic image, which may be in excess of 50 Mbits, is too large fordownloading. However, a decimated version of that image advantageouslycan be downloaded over very low speed comm channel 230 in a few seconds.While a digital image of 50-100 Kbits is not sufficient to allow thediagnostic physician to render a diagnosis, that digital image includessufficient detail to allow the diagnostic physician to determine, duringstep 610, whether he/she desires to read the particular EMI. When thediagnostic physician does not wish to read the currently previewed EMI,the diagnostic physician rejects the EMI and the DCN is deselected;thus, the other diagnostic physicians are no longer locked out of therejected EMI.

It will be appreciated that, alternatively, the diagnostic physicianmerely receives a list of arrays of PBQs, each array having patient EMIsavailable for reading during step 608. He/she is also told what thehighest bid price is in each array. When he/she subsequently selects oneof the arrays, it results in several simultaneous actions in CHC 200.First, the CHC 200 automatically picks the highest current bid EMI inthe selected array and locks out all other diagnostic physicians fromthat EMI. Second, the CHC 200 transmits patient information, whichpreferably is displayed in area 412 on the screen of computer 410, and apreview image corresponding to either the sole or first digitizeddiagnostic image in the patient's EMI. As previously mentioned, the sizeof the actual digitized diagnostic image is too large for downloading; adecimated version of that image advantageously can be downloaded overlow speed comm channel 230 in a few seconds, so that the diagnosticphysician can determine, during step 610, whether he desires to read theparticular EMI. When the diagnostic physician does not wish to read thecurrently previewed EMI, the diagnostic physician rejects the EMI and itis deselected; thus, the other diagnostic physicians are no longerlocked out of the EMI.

Thus, if for any reason the physician decides not to read the patient'sEMI, the diagnostic physician can reject the EMR containing the EMI,which EMR will then be placed back at the top of the selected PBQ. Itwill be appreciated that the diagnostic physician is under no obligationto read an EMI. On the other hand, the diagnostic physician has anobligation, once he/she has started to preview the EMI, to either readthe EMI or refuse it quickly. In short, the diagnostic physician mustselect the DCN of a corresponding EMR, preview the EMI containedtherein, and decide whether he/she will read or refuse the image. Thismeasure is designed to eliminate the possibility of EMI stockpiling byradiologists, e.g., radiologists who may otherwise come in the morningand start downloading EMIs but won't read the EMIs until much later inthe day.

When the diagnostic physician desires to read the previewed EMI, thediagnostic physician requests that the EMR with its associated EMI bedownloaded from CHC 200 to computer 410 via high speed comm channel 220,during step 612. Unlike the comm channel 210 between computer 310 andCHC 200, where the method and speed of transmission is irrelevant, thespeed of transmission using comm channel 220 between the CHC 200 and thediagnostic physician's office 400 is crucial. In order to efficientlyemploy the downtime of the diagnostic physician pool, which downtimetends to come at unpredictable times and be of short duration, the EMIsmust not only be ready when the diagnostic physician is ready but mustbe capable of being downloaded rapidly. For example, a typical radiologyimage could be as large as 50 MB. Therefore, to take advantage of thetypical 15 minute downtime, the patient's EMI should be completelydownloaded in one or two minutes. For that reason, high bandwidth links,e.g., 1 Mbit/sec or higher, are particularly advantageous. Thus, asdiscussed above, the high speed comm channel 220 advantageously could beprovided by a T1 line, a satellite comm system, cable modem linesequipped for bulk data transmission, etc. It will be appreciated thattransmission of the complete EMR advantageously can be downloaded insubstantially the same time, since the difference between the EMI andthe complete EMR is the EMF.

It should also be mentioned that given sufficient bandwidth in commchannel 220, the process of downloading the patient's EMR containing theimage to be read could also include additional image processingoperations beyond the basic image transfer. For example, during step608, the diagnostic physician determines that the x-ray is that for ahand; the diagnostic physician also determines that he/she should payparticular attention to the index finger of that hand. By selecting aparticular area of the x-ray during preview step 608, the diagnosticphysician can download both the original EMI and a blown up (enlarged)image corresponding to the selected area of the x-ray. In otherexemplary cases, the diagnostic physician can order edge enhancement ofan x-ray, image subtraction to remove skeletal features when the softtissue is of interest, or vice versa, and computer-aided screening fortumors and pre-cancerous lesions. Thus, the CHC 200 first downloads theEMI itself and then downloads the requested value-added image(s). Itwill be appreciated that the RAMIX system advantageously can providediagnostic programs which otherwise would be too expensive for theaverage radiology group to afford, e.g., those located in rural areas.

During step 614, the diagnostic physician reads the patient's EMI, i.e.,the patient's EMI appears on the screen of the computer 410 and thediagnostic physician performs his/her diagnosis and prepares his/herwritten diagnosis report. When the written diagnosis report for thereading has been completed, the diagnostic physician transmits his/herdiagnosis during step 616 via 618, the CHC 200 transmits the writtendiagnosis report to the computer 510 in the patient/gatekeeper's office500 via comm channel 240, in an exemplary case. It will be appreciatedthat the report may be routed to the patient/gatekeeper by anyconventional method selected by the patient/gatekeeper, although thereport may advantageously be transmitted to CHC 200 so as to prevent theRAMIX system from falsely determining that the EMI has not been read ina timely fashion, as discussed in detail below.

It should be mentioned that area 416 of the screen of the computer 410advantageously displays a form for recording the diagnostic physician'sreading and that the digitized diagnostic image forming the EMIadvantageously can be displayed on the area 418 of the screen ofcomputer 410. The screen of computer 410 is preferably a high resolutiongraphic display monitor and not a conventional SVGA computer monitor.Advantageously, the diagnostic physician reads the digitized diagnosticimage and writes his/her diagnosis directly into the form provided incomputer screen area 416. The diagnostic physician advantageously canemploy voice recognition software with a specialized medical dictionarymodule to improve his/her efficiency still further.

It should also be mentioned that in the exemplary case being discussedall EMIs have a predetermined time limit within which the EMI must beread once it has been uploaded to computer 410, as discussed above; if adiagnosis has not been uploaded to the CHC 200 from the computer 410within a predetermined period of time, the patient's EMR is placed backin the PBQ from whence it came and the diagnostic physician who failedto respond in a timely manner is not allowed to file a diagnosis report.Moreover, the operating software of the CHC 200 advantageously cancontain features to lock out a diagnostic physician who repeatedly failsto submit a timely diagnosis within the allotted predetermined period oftime.

It will be appreciated that many alternative methods for operating theRAMIX system advantageously can be employed within the scope of thepresent invention. For example, it would be possible to operate thesystem on a flat fee basis. In this alternative embodiment, the patienttransmits his/her EMR containing the EMI to the CHC 200 via comm channel210, as discussed above. With this configuration, instead of a pluralityof PBQs with different bid prices, there is only one PBQ. DCNs forcorresponding EMRs are placed in the single PBQ, with the DCNs arrangedin time of receipt order. When a diagnostic provider has downtime andwishes to perform a reading, the diagnostic physician connects to theRAMIX system and downloads an EMR containing the selected EMI.

It will be noted that this alternative embodiment i.e., non-bid patientqueues, provides only reasonable time delivery of EMIs but stillachieves greater efficiency and improved health care. It should bementioned that since no direct bidding is permitted, patients have nomechanism to indicate the subjective priority of their EMIs to thediagnostic physician. In this alternative embodiment of the presentinvention, patients are charged a flat rate while providers are given aflat fee. All other technical aspects of the RAMIX system are the sameas illustrated in FIG. 3.

Advantageously, the flat rate method could be employed by an institutionthat wishes to lock in a predetermined price and for diagnosticproviders who wish to lock in a predetermined fee. For example, VAHospitals could employ this method to reduce their overall operatingcosts for diagnostic services.

It should also be mentioned that the alternative preferred embodimentcould be operated in parallel with the system according to the preferredembodiment. This would pose no technical problems as access to the flatfee portion of the overall system could easily be restricted toparticular patients and predetermined diagnostic providers. In theexemplary case under discussion, the RAMIX system is still aself-organizing distribution system providing “just in time images.”

Another interesting alternative method for operating the RAMIX systemaccording to the present invention is the so-called open market directbid method of operation. In an exemplary case, the patient transmitshis/her EMR to CHC 200 via comm channel 210 as a work order the patientwould like to receive bids on. The diagnostic physicians currentlyexperiencing downtime would then bid against one another for theprivilege of performing the reading. Advantageously, a time limit isestablished, e.g., one hour, and during that time diagnostic physicianswould bid on performing the reading. At the end of the predeterminedtime period, the diagnostic physician with the lowest bid would beawarded the reading. It should be mentioned that with this particularmethod of operating the RAMIX system, the diagnostic physicians biddingfor a particular reading would be bidding for an EMI which could be readduring the next down period that occurs after the bidding closes. Itshould also be mentioned that the bids need not be restricted tomonetary amounts. Patients are free to establish other criteria for thesuccessful bidder such as: how fast the reading must be done; the typeof subspecialty the diagnostic physician must have, etc. All of thesefactors and more advantageously could go into evaluating the bids anddetermining the successful bidder. It will noted that the RAMIX systemperforms the evaluation according to the criteria established by thepatient/gatekeeper.

In summary, the RAMIX system according to the present invention changesthe dynamics of the interaction between patients and the diagnosticproviders by acting as a buffer storing EMIs while a contract fordiagnostic services is formed between a patient and a diagnosticphysician. Moreover, the RAMIX system according to the present inventionprovides “managed care”, i.e., it is managed by the patient and theprovider, in contrast with most so-called “managed care organizations”,which are really organizations chartered to “limit care.” Since theRAMIX system provides patients with an avenue for bidding on the average30% downtime experienced by most diagnostic physicians, the RAMIX systemand the corresponding method of operation according to the presentinvention provide a mechanism for reducing the average cost ofdiagnostic services. Thus, the rates for such services should beconsiderably lower. Moreover, the improved efficiency made possible byemploying the RAMIX system according to the present invention couldresult in the elimination of 10% to 20% of the currently practicingdiagnostic providers, e.g., physicians who are not board certified intheir avowed specialty.

Advantageously, the RAMIX system and the corresponding operating systemaccording to the present invention are designed to automate the overallprocess of diagnostic delivery and reporting. It will be appreciatedthat there are readings that are now considered undesirable because ofthe radiologists' perception that they can't “make any money” on thesereadings. But it isn't the type of EMI that is the problem, it's theinefficient fashion in which the EMR and its included EMI is usuallyhandled. If the distribution process could be made more efficient, thistype of EMI would be more desirable, or at least less undesirable. Itwill also be appreciated that the RAMIX system could also be coordinatedwith electronic claims processing systems and methods such as thosedisclosed in copending, commonly owned application Ser. No. 08/823,977(now abandoned), Ser. No. 08/824,010 (now U.S. Pat. No. 6,003,007), andSer. No. 08/823,978 (now abandoned), which applications are incorporatedherein by reference for all purposes.

Advantageously, the RAMIX system and corresponding operating methodaccording to the present invention provide a mechanism for obtainingwhat amounts to “service on demand” at a discount price. It will beappreciated that, at present, there are no differences between readingsdone on an emergency basis and those performed on a routine basis. TheRAMIX system provides a mechanism for doing emergency readings, withonly a small premium being paid for the expedited service. That is, thepatient/gatekeeper examines the Patient Bid Queues, finds the highestbid price, and then bids a little higher.

Beneficially, the RAMIX system and corresponding operating method couldbe used, because of the potentially fast turn around time, to bringreadings back into the radiology world that are currently being done bynon-diagnostic physicians, e.g. orthopedists and chiropractors. Thisalso permits malpractice insurance companies to lower premiums forproviders who use the service. Having a diagnostic physician do thereading instead of a chiropractor would improve the general health careof the patient while at the same time lowering the malpractice riskexposure of the chiropractor. It will be appreciated that in the NewYork City area alone, chiropractors generate approximately 1,000 imagesper day.

With respect to improvements in overall health care, it will beappreciated that the method of operating the RAMIX system couldaccommodate all Managed Care Organizations that demand that theirpatients put their EMIs on this system, assuming that the Managed Careoperator could receive a lower cost for diagnostic services.Additionally, the Managed Care operator might demand that all affiliatedproviders be connected to the RAMIX system. Moreover, the RAMIX systemhas the potential to expand and improve the quality of radiological 1image read 1 diagnostic services which are available in rural and otherpresently “under serviced areas.”

It should also be mentioned that the method of operation of the RAMIXsystem could be modified to accommodate second opinions. For example,the patient/gatekeeper could desire a second opinion. When completingthe EMF of the EMR, the patient/gatekeeper could include a code in oneof the fields indicative of this preference. When the EMR and itsassociated EMI is uploaded to CHC 200, the EMR goes to the storage areaand two different DCNs go into the selected PBQ, with the first andsecond DCNs being time separated from one another by a predeterminedtime interval or a time interval based on velocity through the selectedPBQ. When both of the DCNs are selected, the EMI is downloaded twice andtwo independent readings are performed. When the CHC 200 receives bothreadings from the diagnostic physicians, the CHC 200 forwards them bothto the patient/gatekeeper.

Other modifications and variations to the invention will be apparent tothose skilled in the art from the foregoing disclosure and teachings.Thus, while only certain embodiments of the invention have beenspecifically described herein, it will be apparent that numerousmodifications may be made thereto without departing from the spirit andscope of the invention.

1-7. (canceled)
 8. A computer system configured by software to execute amethod, the computer system comprising: memory; wherein the memory ofthe computer system contains in a database: a plurality of links torespective digital information blocks, wherein each of the links refersto a single one of the digital information blocks; in association witheach link, a bid amount; and in association with each link, descriptiveinformation; and wherein the method comprises: receiving, from a remotecomputer, which is external to the computer system, an electroniccommunication comprising information; and transmitting at least aportion of an ordered list of links to the remote computer; wherein thelinks of the ordered list of links are selected links of the pluralityof links for which at least some of the associated descriptiveinformation matches at least some of the electronic communicationinformation; wherein the ordered list of links has been arranged into anorder being determined responsive to at least the software and the bidamount associated with each of the links of the plurality of links; andwherein the computer system configures the list of links to give a userof the remote computer the ability to select any one of the links and,by using the selected link, to electronically download the digitalinformation block associated with the selected link, for viewing datacontained therein.
 9. A computer system configured by software toexecute a method, for arranging and transmitting a list of links, themethod comprising the steps of: storing a set of links, each linkreferring to a respective digital information block; associating a bidamount with each link; associating descriptive information with eachlink; receiving an electronic communication comprising information froma remote computer, which is external to the computer; selecting links inthe set of links whose associated descriptive information includes atleast some of the electronic communication information; arranging theselected links into an ordered list of links, said order beingdetermined responsive to the software and to at least the bid amountassociated with each of the selected links; and transmitting at least aportion of an ordered list of links to the remote computer; wherein thecomputer system configures the list of links to give a user of theremote computer the ability to select any one of the links and, by usingthe selected link, to electronically download the digital informationblock associated with the selected link, for viewing data containedtherein.
 10. A computer system configured by software to execute amethod, the computer system comprising: memory; wherein the memory ofthe computer system stores: a plurality of links to respective digitalinformation blocks, wherein each of the links refers to a single one ofthe digital information blocks; in association with each link, a bidamount; and in association with each link, descriptive information; andwherein the method comprises: comparing the descriptive informationassociated with each of the plurality of links to a set of information;selecting a subset of links of the plurality of links for which at leastsome of the associated descriptive information matches at least some ofthe set of information; arranging the subset of links into an orderbeing determined responsive to at least the software and the bid amountassociated with each of the links of the subset of links, therebygenerating an ordered list of links; and transmitting at least a portionof the ordered list of links to a remote computer which is external tothe computer system; wherein the computer system configures the list oflinks to give a user of the remote computer the ability to select anyone of the links and, by using the selected link, to electronicallydownload the digital information block associated with the selectedlink, for viewing data contained therein.